Q&A: Establishing an escalation policy for inappropriate queries

CDI Strategies - Volume 17, Issue 5

Q: What is the best way to handle a query that has been written inappropriately?

A: If I understand your question correctly, it seems like there might be a situation where it was discovered that some queries were questionably written. By “questionable” I mean that they are either not following the ACDIS/AHIMA Guidelines for Achieving a Compliant Query Practice brief, or the queries were written for fraudulent purposes.

Whether the issue is intentional, a lack of education, or lack of experience, it is something that needs to be rectified as soon as possible. This can be accomplished by having an escalation policy in place for these types of situations. Remember you also have a compliance department that can be extremely helpful.

Many organizations now have a formal auditing process in place for their queries. This process can be an internal or an external process, but the key is that once you have the results of the audit, you need a plan in place for how to proceed. If the audit doesn’t uncover any concerns, then you don’t have a problem and the main goal would be to continue updating staff with education. When you find issues like poorly written or noncompliant queries, however, what’s the best way to handle it?

My recommendation would be to have an escalation policy in place that is internally approved and spells out exactly what the next move would be. Your first step might be the identification of the problem and deciding who it would be reported to. The next step may have suggestions on how to reconcile the issue, whether it is through education or some sort of counseling, and who would be responsible for addressing the issue (e.g., a manager? Team lead? Educator?). The third step may include some type of follow-up and a schedule for when and how often this would occur. Another step may include what to do when a situation doesn’t progress towards a positive outcome.

A robust escalation policy protects both leadership and the others involved in the process. Like I mentioned earlier, make sure whatever you decide upon that it is internally reviewed, approved, and updated on at least an annual basis.

Editor’s note: Sharme Brodie RN, CCDS, CCDS-O, CRC, CDI education specialist for ACDIS/HCPro, based in Middleton, Massachusetts, answered this question. Contact her at sbrodie@acdis.org.

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